Racing 4 Kids' Health
Establishing Priorities in Canadian Child & Youth Health Research
Table of Contents
- Introduction
- The Physical Environment
- The Social Environment
- Obesity and Physical Inactivity
- Intentional and Unintentional Injury
- Conclusion
- About This Publication
- About the Partners
ISBN 978-0-9783435-1-4
1. Introduction
The true measure of a nation's standing is how well it attends to its children.
-UNICEF, 2007
Children and youth represent more than one quarter of Canada's population and the future of our country. While significant progress has been made in recent decades towards improving the health and well-being of our youngest citizens, many of the problems still facing this population require solutions that can be addressed only through the rapid and efficient creation of new knowledge in areas of national importance.
Canada is already recognized internationally in the following areas of child health research:
- Developmental biology (how a healthy embryo, fetus, and infant are formed, and how stem cells function)
- Maternal-fetal endocrinology and physiology (the biology underlying pregnancy and birth)
- Developmental psychology and child mental health (healthy and unhealthy development of cognition and behaviour)
- Clinical trials (testing of health care interventions in pregnant women, infants, and children)
- Perinatal epidemiology (study of variations in population-level health of mothers and infants, and the reasons for those variations)
- Perinatal health services research (use of clinical and administrative data to assess and improve the quality of obstetric and neonatal care)
Canadian expertise in these areas has had major international impacts on clinical practice and public health policy:
- Clinical guidelines and practice concerning routine induction in post-term pregnancies; cesarean vs vaginal delivery of fetuses in the breech position; the use of indomethacin and caffeine to prevent brain hemorrhage and apnea, respectively, in preterm infants; and the treatment of children with acute respiratory infections and asthma
- World Health Organization and Health Canada recommendations for the optimal duration of exclusive breastfeeding
- The importance of early intervention to reduce aggressive and other problem child behaviors
- Changes in neonatal intensive care practices across Canada that have led to declines of 40% in hospital-acquired infection and 20% in chronic lung disease
The Canadian Institutes of Health Research's Institute of Human Development, Child and Youth Health (CIHR-IHDCYH), the National Child and Youth Health Coalition (NCYHC), and SickKids Foundation now propose to harness Canada's strengths to confront the major health issues facing our children: the physical environment, the social environment, the growing epidemic of obesity and physical inactivity, and unintentional and intentional injury. In the section that follows, CIHR-IHDCYH, NCYHC and SickKids Foundation provide salient facts related to child and youth health in Canada, list key gaps in our knowledge that future research should attempt to fill, and suggest how the new knowledge can be applied to improve the health and healthcare of Canada's children and youth.
2. The Physical Environment
We are conducting a vast toxicology experiment in which our children and our children's children are the experimental subjects.
-Dr. Herbert Needleman, University of Pittsburgh
The Facts
The developing embryo, fetus, and infant are particularly vulnerable to the potential effects of environmental hazards; damage can be irreversible and create long-term problems. Moreover, infant's and children's behaviours (crawling, mouthing) bring them in close contact with potentially toxic substances.
- Aboriginal children and children living in poverty are at increased risk for exposure to environmental hazards.
- Many changes have occurred over the last few decades in the construction, insulation, heating, and ventilation of Canadian homes. These changes have affected the quality of indoor air in homes, where Canadian infants and young children spend the majority of their time. Because asthma, the most common chronic childhood illness in Canada, has increased 4-fold in prevalence over the same time period, it is suspected that this increase may be related to changes in home air quality.
Gaps in Knowledge
Effects of low-level exposures to a wide range of environmental toxicants on the development of the embryo and fetus (including the risks of birth defects, miscarriage, stillbirth, preterm birth, and growth restriction) and on long-term brain development and behaviour
- Effects of indoor air quality on the risks of developing asthma and allergies
Applying the New Knowledge
Regulate air, water, food, and other consumer products to reduce exposures shown to be harmful
- Develop new housing construction, insulation, and ventilation standards to reduce exposure to chemicals, molds, and allergens shown to increase risks of asthma or allergy
- Reassure the public regarding exposures without adverse effects
3. The Social Environment
Health outcomes and well-being are intimately and intricately related to the social world within which each child lives. Indeed, for many health outcomes, differences in health status are more closely tied to psychosocial and economic factors than to biological differences.
-SickKids Foundation, Environmental Scan, 2004
The Facts
In 2002, 1 in 6 Canadian children was living below Statistics Canada's low income cutoff.
- Children who grew up in poverty are at higher risk for a variety of problems, including hyperactivity, emotional distress, and failing at school.
- Children with a disability or chronic disease are at increased risk of social isolation, poor school adjustment, and mental health problems.
- Among Canadian youth aged 15 to 17, First Nations smoking rate are 3-4 times higher than non-Aboriginal rates.
Gaps in Knowledge
Impact of daycare and other early childhood programs on neurocognitive development and behaviour
- Community and family risk factors for child and youth mental health and addiction
- Child, family, and community characteristics and interventions that improve children's success in school
Applying the New Knowledge
Implement or reinforce programs shown to be beneficial for development, behaviour, and school success
- Discontinue programs shown to be ineffective or harmful
4. Obesity and Physical Inactivity
For the first time in record history, today's younger generation will live shorter lives than their parents.
-Olshansky et al, New England Journal of Medicine, 2005
The Facts
The proportion of Canadian children and youth who are overweight or obese has jumped from 15% to 26% in the last 25 years.
- It is estimated that obesity and physical inactivity may reduce life expectancy by 3-5 years over the next 40 years - similar to the number of potential years of life lost due to cancer.
- Changes in lifestyle have been particularly devastating in Canada's Aboriginal communities. In many Aboriginal families, poverty limits access to healthy dietary choices and to opportunities to engage in physical activity. These factors, combined with an underlying genetic susceptibility, have led to an epidemic of type 2 diabetes.
Gaps in Knowledge
Characteristics of neighborhoods, communities, and regions that are associated with risks of obesity and physical inactivity
- Development and testing of home-, school-, and community-based incentives and interventions to reduce energy intake and increase physical activity and fitness
Applying the New Knowledge
Disseminate emerging findings to the general public, schools, and local, provincial/territorial, and federal governments
- Implement incentives and programs that prevent overnutrition and promote physical activity and fitness
5. Intentional and Unintentional Injury
Many people see injuries as "accidents" or as something that happens to others. Yet if more people knew the burden of injury and understood that injuries can be prevented, society would not tolerate the impact of this invisible epidemic.
-Safe Kids Canada, 2006
The Facts
Injury is the leading cause of death in Canadian children and youth. More than 730 children and youth in Canada under age 20 died as a result of unintentional injury in 2003.
- Between 1994 and 2003, an average of 25,500 children under the age of 14 years were hospitalized per year for serious injury, including complex fractures and injuries to the brain and other internal organs.
- Children maltreatment can have profound and long-lasting effects in mental health and well-being. Rates of hospitalization for assault, abuse, and neglect vary by age; infant and youth aged 15-19 show the highest rates.
- Children with disabilities are at increased risk of physical and sexual abuse.
- Canada's youth suicide rate is the third highest in the industrialized world. Suicide is second only to fatal motor vehicle accidents as a cause of death in 15-24 year-old Canadians.
- Suicide rates among Canadian Aboriginal youth are 5-6 times higher than among non-Aboriginal youth.
Gaps in Knowledge
Development and testing of improved child restraint devices, and their proper use, in automobiles
- Improved design and testing of child playground and sports equipment
- Modifiable risk factors for child maltreatment and suicide among children and youth
Applying the New Knowledge
Legislate the manufacture and proper use of automobile restraints and playground and sports equipment
- Develop and evaluate programs to prevent child and youth maltreatment and suicide
6. Conclusions
Canada has the capacity to become a world leader in child health research, but achieving that goal requires both the commitment and strategic investment of our leaders and decision-makers. Action taken now to support research efforts designed to address critical gaps in our knowledge base, and applying the new knowledge, will yield large dividends for the lifelong health and quality of life of Canada's children and youth.
7. About this Publication
This is a joint publication of the Canadian Institutes of Health Research - Institute of Human Development, Child and Youth Health (CIHR-IHDCYH), the National Child and Youth Coalition (NCYHC) and SickKids Foundation
8. About the Partners
CIHR-IHDCYH
The CIHR is the Government of Canada's agency for health research. CIHR's mission is to create new scientific knowledge and to catalyze its translation into improved health, more effective health services and products, and a strengthened Canadian health care system. Composed of 13 Institutes, CIHR provides leadership and support to more than 10,000 health researchers and trainees across Canada.
The CIHR-IHDCYH supports research that ensures the best start in life for all Canadians and the achievement of their potential for optimal growth and development. Through our support, researchers address a wide range of health concerns, including those associated with reproduction, early development, childhood, and adolescence. By facilitating partnerships and working to accelerate the transfer of new knowledge, IHDCYH finances and promotes research that addresses the causes of illness, its preventions, screening, diagnosis, treatment, short- and long-term support systems, and palliation for the benefit of Canadian mothers and their children.
Canadian Institutes of Health Research
Institute of Human Development, Child and Youth Health
The Montreal Children's Hospital
2300 Tupper Street, Les Tourelles, T-118
Montreal, QC H3H 1P3
Telephone: 514-412-4414
Facsimile: 514-412-4253
NCYHC
Formed in 2004, the NCYHC is a collaboration of five major national pediatric organizations working together to advance the cause of child and youth health and health care in Canada. The Coalition comprises the Canadian Association of Pediatric Health Centres (CAPHC), the Canadian Child Health Clinician Scientist Program (CCHCSP), the Council of Canadian Child Health Research (CCCHR), the Pediatric Chairs of Canada (PCC), and the Pediatric Surgical Chiefs of Canada (PSCC). While each organization holds distinct mandates, the Coalition shares many common goals and objectives.
The NCYHC provides a powerful framework for stimulating new knowledge development and promoting the uptake and application of knowledge to practice and policy. It also serves to support training and education initiatives and to strengthen national advocacy towards improving the health and health care of Canada's young population.
National Child and Youth Health Coalition
401 Smyth Road, Room 1161
Ottawa, ON K1H 8L1
Telephone: 613-737-2695
Facsimile: 613-738-3247
SickKids Foundation
SickKids Foundation is the largest non-governmental granting agency in child health in Canada. The Foundation's vision is Healthier Children - A better world. Since its establishment in 1972, SickKids Foundation has granted over $500 million to The Hospital for Sick Children and over $60 million to researchers across the country. Through it National Grants Program, SickKids Foundation invests $4 million annually across Canada in child health research, building upon SickKids' work as an international leader in pediatric health care, education, and research. The Program's strategic vision consists of two principle foci: development of skills amongst the next generation of child health researchers, and knowledge generation in specific areas which are important to children's health and which are not being addressed elsewhere.
SickKids Foundation
525 University Avenue
Toronto, ON M5G 2L3
Telephone: 416-813-6166
Facsimile: 416-813-7311
